胃・十二指腸出血の病態―出血性胃・十二指腸潰瘍手術例からみた検討

Clinicopathological Study on Bleeding Gastroduodenal Ulcers

要旨　最近10年間の出血性胃・十二指腸潰瘍手術例134例からみた胃・十二指腸出血の病態について検討した．非観血的止血法が施行されていない82例と非観血的止血法施行後に手術となった52例の2群に分けて分析し，前者において胃潰瘍では短時間のうちに大量の輸血を要するものが多く緊急手術率が高かったが，十二指腸潰瘍では比較的緩やかに出血するものが多く待期手術のほうが多かった．潰瘍の性状別では，慢性潰瘍より急性潰瘍のほうに重症例が多く，露出血管の有無では露出血管を認めたものに重症例が多かった．後者においては非観血的止血法が無効と考えられたものが65％であり，潰瘍の性状別にみると急性潰瘍に無効例が多かった．前者と後者の比較では後者において緊急手術率がやや低く輸血量も減少しており差がみられた．

　Study was conducted regarding pathophysiology of bleeding gastroduodenal ulcer seen in 134 cases experienced in the past 10 years. Cases were divided into the two groups according to whether non-invasive hemostatic procedure was performed or not prior to surgical treatment. Eighty-two cases did not receive non-invasive procedure, while the remaining 52 cases received it.

　The former group was distinguished in that most of the gastric ulcer cases required large amount of blood transfusion in short time of period and emergency operation. Most of the duodenal ulcer cases, however, in this same group bled gradually and underwent elective operation. The proportion of acute ulcer was higher than that of chronic ulcer in severe cases and the presence of exposed vessels was associated with the severity of the disease.

　On the other hand, non-invasive hemostatic procedure was considered ineffective in 65% of the latter group. Most of these cases had acute ulcer. The latter group had lower rate of emergency operation and received smaller amount of blood transfusion than the former group.